By: Rosson S.B. No. 1161
A BILL TO BE ENTITLED
AN ACT
1-1 relating to out-of-hospital do-not-resuscitate orders; providing
1-2 penalties.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subtitle A, Title 8, Health and Safety Code, is
1-5 amended by adding Chapter 674 to read as follows:
1-6 CHAPTER 674. OUT-OF-HOSPITAL DO-NOT-RESUSCITATE
1-7 Sec. 674.001. DEFINITIONS. In this chapter:
1-8 (1) "Attending physician" means the physician who has
1-9 primary responsibility for a person's treatment and care.
1-10 (2) "Board" means the Texas Board of Health.
1-11 (3) "Cardiopulmonary resuscitation" includes a
1-12 component of cardiopulmonary resuscitation.
1-13 (4) "Competent" means possessing the ability, based on
1-14 reasonable medical judgment, to understand and appreciate the
1-15 nature and consequences of a treatment decision, including the
1-16 significant benefits and harms of, and reasonable alternatives to,
1-17 a proposed treatment decision.
1-18 (5) "Declarant" means a person who has executed or
1-19 issued an out-of-hospital do-not-resuscitate order under this
1-20 chapter.
1-21 (6) "Department" means the Texas Department of Health.
1-22 (7) "DNR identification device" means an
1-23 identification device specified by the board under Section 674.023
1-24 that is worn for the purpose of identifying a person who has
2-1 executed or issued an out-of-hospital DNR order or on whose behalf
2-2 an out-of-hospital DNR order has been executed or issued under this
2-3 chapter.
2-4 (8) "Durable power of attorney for health care" means
2-5 a document delegating to an agent the authority to make health care
2-6 decisions for a person in accordance with Chapter 135, Civil
2-7 Practice and Remedies Code.
2-8 (9) "Emergency medical services" has the meaning
2-9 assigned by Section 773.003.
2-10 (10) "Emergency medical services personnel" has the
2-11 meaning assigned by Section 773.003.
2-12 (11) "Health care professionals" means physicians,
2-13 nurses, and emergency medical services personnel and, unless the
2-14 context requires otherwise, includes hospital emergency personnel.
2-15 (12) "Incompetent" means lacking the ability, based on
2-16 reasonable medical judgment, to understand and appreciate the
2-17 nature and consequences of a treatment decision, including the
2-18 significant benefits and harms of, and reasonable alternatives to,
2-19 a proposed treatment decision.
2-20 (13) "Life-sustaining procedure" means a medical
2-21 procedure, treatment, or intervention that uses mechanical or other
2-22 artificial means to sustain, restore, or supplant a spontaneous
2-23 vital function and, when applied to a person in a terminal
2-24 condition, serves only to prolong the process of dying. The term
2-25 does not include the administration of medication or the
2-26 performance of a medical procedure considered to be necessary to
2-27 provide comfort or care or to alleviate pain or the provision of
3-1 water or nutrition.
3-2 (14) "Out-of-hospital DNR order":
3-3 (A) means a legally binding out-of-hospital
3-4 do-not-resuscitate order, in the form specified by the board under
3-5 Section 674.003, prepared and signed by the attending physician of
3-6 a person who has been diagnosed as having a terminal condition,
3-7 that documents the instructions of a person or the person's legally
3-8 authorized representative and directs health care professionals
3-9 acting in an out-of-hospital setting not to initiate or continue
3-10 the following life-sustaining procedures:
3-11 (i) cardiopulmonary resuscitation;
3-12 (ii) endotracheal intubation or other
3-13 means of advanced airway management;
3-14 (iii) artificial ventilation;
3-15 (iv) defibrillation;
3-16 (v) transcutaneous cardiac pacing;
3-17 (vi) the administration of cardiac
3-18 resuscitation medications; and
3-19 (vii) other life-sustaining procedures
3-20 specified by the board under Section 674.023(a); and
3-21 (B) does not include authorization to withhold
3-22 medical interventions or therapies considered necessary to provide
3-23 comfort or care or to alleviate pain or to provide water or
3-24 nutrition.
3-25 (15) "Out-of-hospital setting" means any setting
3-26 outside of a licensed acute care hospital in which health care
3-27 professionals are called for assistance, including long-term care
4-1 facilities, in-patient hospice facilities, private homes, and
4-2 vehicles during transport.
4-3 (16) "Physician" means a physician licensed by the
4-4 Texas State Board of Medical Examiners or a properly credentialed
4-5 physician who holds a commission in the uniformed services of the
4-6 United States and who is serving on active duty in this state.
4-7 (17) "Proxy" means a person designated and authorized
4-8 by a directive executed or issued in accordance with Chapter 672 to
4-9 make a treatment decision for another person in the event the other
4-10 person becomes comatose, incompetent, or otherwise mentally or
4-11 physically incapable of communication.
4-12 (18) "Qualified relatives" means those persons
4-13 authorized to execute or issue an out-of-hospital DNR order on
4-14 behalf of a person who is comatose, incompetent, or otherwise
4-15 mentally or physically incapable of communication under Section
4-16 674.008.
4-17 (19) "Statewide out-of-hospital DNR protocol" means a
4-18 set of statewide standardized procedures adopted by the board under
4-19 Section 674.023 for withholding cardiopulmonary resuscitation and
4-20 certain other life-sustaining procedures by health care
4-21 professionals acting in out-of-hospital settings.
4-22 (20) "Terminal condition" means an incurable or
4-23 irreversible condition caused by injury, disease, or illness that
4-24 would produce death without the application of life-sustaining
4-25 procedures, according to reasonable medical judgment, and in which
4-26 the application of life-sustaining procedures serves only to
4-27 postpone the moment of the person's death.
5-1 Sec. 674.002. OUT-OF-HOSPITAL DNR ORDER; DIRECTIVE TO
5-2 PHYSICIANS. (a) A competent person who has been diagnosed by a
5-3 physician as having a terminal condition may at any time execute a
5-4 written out-of-hospital DNR order directing health care
5-5 professionals acting in an out-of-hospital setting to withhold
5-6 cardiopulmonary resuscitation and certain other life-sustaining
5-7 procedures designated by the board.
5-8 (b) The declarant must sign the out-of-hospital DNR order in
5-9 the presence of two witnesses, and those witnesses must sign the
5-10 order. The attending physician of the declarant must sign the
5-11 order and shall make the fact of the existence of the order and the
5-12 reasons for execution of the order a part of the declarant's
5-13 medical record.
5-14 (c) A witness must have the same qualifications as those
5-15 provided by Section 672.003(c).
5-16 (d) If the person is incompetent but previously executed or
5-17 issued a directive to physicians in accordance with Chapter 672,
5-18 the physician may rely on the directive as the person's
5-19 instructions to issue an out-of-hospital DNR order and shall place
5-20 a copy of the directive in the person's medical record. The
5-21 physician shall sign the order in lieu of the person signing under
5-22 Subsection (b).
5-23 (e) If the person is incompetent but previously executed or
5-24 issued a directive to physicians in accordance with Chapter 672
5-25 designating a proxy, the proxy may make any decisions required of
5-26 the designating person as to an out-of-hospital DNR order and shall
5-27 sign the order in lieu of the person signing under Subsection (b).
6-1 (f) If the person is now incompetent but previously executed
6-2 or issued a durable power of attorney for health care in accordance
6-3 with Chapter 135, Civil Practice and Remedies Code, designating an
6-4 agent, the agent may make any decisions required of the designating
6-5 person as to an out-of-hospital DNR order and shall sign the order
6-6 in lieu of the person signing under Subsection (b).
6-7 (g) The board, on the recommendation of the department,
6-8 shall by rule adopt procedures for the disposition and maintenance
6-9 of records of an original out-of-hospital DNR order and any copies
6-10 of the order.
6-11 (h) An out-of-hospital DNR order is effective on its
6-12 execution.
6-13 Sec. 674.003. FORM OF OUT-OF-HOSPITAL DNR ORDER. (a) A
6-14 written out-of-hospital DNR order shall be in the standard form
6-15 specified by board rule as recommended by the department.
6-16 (b) The standard form of an out-of-hospital DNR order
6-17 specified by the board must, at a minimum, contain the following:
6-18 (1) a distinctive single-page format that readily
6-19 identifies the document as an out-of-hospital DNR order;
6-20 (2) a title that readily identifies the document as an
6-21 out-of-hospital DNR order;
6-22 (3) the printed or typed name of the person;
6-23 (4) a statement that the physician signing the
6-24 document is the attending physician of the person, that the
6-25 physician has diagnosed the person as having a terminal condition,
6-26 and that the physician is directing health care professionals
6-27 acting in out-of-hospital settings not to initiate or continue
7-1 certain life-sustaining procedures on behalf of the person, and a
7-2 listing of those procedures not to be initiated or continued;
7-3 (5) a statement that the person understands that the
7-4 person may revoke the out-of-hospital DNR order at any time by
7-5 destroying the order and removing the DNR identification device, if
7-6 any, or by communicating to health care professionals at the scene
7-7 the person's desire to revoke the out-of-hospital DNR order;
7-8 (6) places for the printed names and signatures of the
7-9 witnesses and attending physician of the person and the medical
7-10 license number of the attending physician;
7-11 (7) a separate section for execution of the document
7-12 by the legal guardian of the person, the person's proxy, an agent
7-13 of the person having a durable power of attorney for health care,
7-14 or the attending physician attesting to the issuance of an
7-15 out-of-hospital DNR order by nonwritten means of communication or
7-16 acting in accordance with a previously executed or previously
7-17 issued directive to physicians under Section 674.002(d) that
7-18 includes the following:
7-19 (A) a statement that the legal guardian, the
7-20 proxy, the agent, the person by nonwritten means of communication,
7-21 or the physician directs that the listed life-sustaining procedures
7-22 should not be initiated or continued in behalf of the person; and
7-23 (B) places for the printed names and signatures
7-24 of the witnesses and, as applicable, the legal guardian, proxy,
7-25 agent, or physician;
7-26 (8) a separate section for execution of the document
7-27 by at least two qualified relatives of the person when the person
8-1 does not have a legal guardian, proxy, or agent having a durable
8-2 power of attorney for health care and is comatose, incompetent, or
8-3 otherwise mentally or physically incapable of communication,
8-4 including:
8-5 (A) a statement that the relatives of the person
8-6 are qualified to make a treatment decision to withhold
8-7 cardiopulmonary resuscitation and certain other designated
8-8 life-sustaining procedures under Section 674.008 and, based on the
8-9 known desires of the person or a determination of the best interest
8-10 of the person, direct that the listed life-sustaining procedures
8-11 should not be initiated or continued in behalf of the person; and
8-12 (B) places for the printed names and signatures
8-13 of the witnesses and qualified relatives of the person;
8-14 (9) a place for entry of the date of execution of the
8-15 document;
8-16 (10) a statement that the document is in effect on the
8-17 date of its execution and remains in effect until the death of the
8-18 person or until the document is revoked;
8-19 (11) a statement that the document must accompany the
8-20 person during transport;
8-21 (12) a statement regarding the proper disposition of
8-22 the document or copies of the document, as the board determines
8-23 appropriate; and
8-24 (13) a statement at the bottom of the document, with
8-25 places for the signature of each person executing the document,
8-26 that the document has been properly completed.
8-27 (c) The board may, by rule and as recommended by the
9-1 department, modify the standard form of the out-of-hospital DNR
9-2 order described by Subsection (b) in order to accomplish the
9-3 purposes of this chapter.
9-4 Sec. 674.004. ISSUANCE OF OUT-OF-HOSPITAL DNR ORDER BY
9-5 NONWRITTEN COMMUNICATION. (a) A competent person who is an adult
9-6 may issue an out-of-hospital DNR order by nonwritten communication.
9-7 (b) A declarant must issue the nonwritten out-of-hospital
9-8 DNR order in the presence of the attending physician and two
9-9 witnesses. The witnesses must possess the same qualifications as
9-10 those provided by Section 672.003(c).
9-11 (c) The attending physician and witnesses shall sign the
9-12 out-of-hospital DNR order in that place of the document provided by
9-13 Section 674.003(b)(7) and the attending physician shall sign the
9-14 document in the place required by Section 674.003(b)(13). The
9-15 physician shall make the fact of the existence of the
9-16 out-of-hospital DNR order a part of the declarant's medical record
9-17 and the witnesses shall sign that entry in the medical record.
9-18 (d) An out-of-hospital DNR order issued in the manner
9-19 provided by this section is valid and shall be honored by
9-20 responding health care professionals as if executed in the manner
9-21 provided by Section 674.002.
9-22 Sec. 674.005. EXECUTION OF OUT-OF-HOSPITAL DNR ORDER ON
9-23 BEHALF OF A MINOR. The following persons may execute an
9-24 out-of-hospital DNR order on behalf of a minor:
9-25 (1) the minor's parents;
9-26 (2) the minor's legal guardian; or
9-27 (3) the minor's managing conservator.
10-1 Sec. 674.006. DESIRE OF PERSON SUPERSEDES OUT-OF-HOSPITAL
10-2 DNR ORDER. The desire of a competent person, including a competent
10-3 minor, supersedes the effect of an out-of-hospital DNR order
10-4 executed or issued by or on behalf of the person when the desire is
10-5 communicated to responding health care professionals as provided by
10-6 this chapter.
10-7 Sec. 674.007. PROCEDURE WHEN DECLARANT IS INCOMPETENT OR
10-8 INCAPABLE OF COMMUNICATION. (a) This section applies when a
10-9 person 18 years of age or older has executed or issued an
10-10 out-of-hospital DNR order and subsequently becomes comatose,
10-11 incompetent, or otherwise mentally or physically incapable of
10-12 communication.
10-13 (b) If the adult person has designated a person to make a
10-14 treatment decision as authorized by Section 672.003(d), the
10-15 attending physician and the designated person shall comply with the
10-16 out-of-hospital DNR order.
10-17 (c) If the adult person has not designated a person to make
10-18 a treatment decision as authorized by Section 672.003(d), the
10-19 attending physician shall comply with the out-of-hospital DNR order
10-20 unless the physician believes that the order does not reflect the
10-21 person's present desire.
10-22 Sec. 674.008. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR
10-23 ISSUED OUT-OF-HOSPITAL DNR ORDER AND IS INCOMPETENT OR INCAPABLE OF
10-24 COMMUNICATION. (a) If an adult person has not executed or issued
10-25 an out-of-hospital DNR order and is comatose, incompetent, or
10-26 otherwise mentally or physically incapable of communication, the
10-27 attending physician and the person's legal guardian, proxy, or
11-1 agent having a durable power of attorney for health care may
11-2 execute an out-of-hospital DNR order on behalf of the person.
11-3 (b) If the person does not have a legal guardian, proxy, or
11-4 agent, the attending physician and at least two qualified relatives
11-5 may execute an out-of-hospital DNR order in the same manner as a
11-6 treatment decision made under Section 672.009(b).
11-7 (c) A decision to execute an out-of-hospital DNR order made
11-8 under Subsection (a) or (b) must be based on knowledge of what the
11-9 person would desire, if known.
11-10 (d) An out-of-hospital DNR order executed under Subsection
11-11 (b) must be made in the presence of at least two witnesses who
11-12 possess the same qualifications that are required by Section
11-13 672.003(c).
11-14 (e) The fact that an adult person has not executed or issued
11-15 an out-of-hospital DNR order does not create a presumption that the
11-16 person does not want a treatment decision made to withhold
11-17 cardiopulmonary resuscitation and certain other designated
11-18 life-sustaining procedures designated by the board.
11-19 Sec. 674.009. COMPLIANCE WITH OUT-OF-HOSPITAL DNR ORDER.
11-20 (a) When responding to a call for assistance, health care
11-21 professionals shall honor an out-of-hospital DNR order in
11-22 accordance with the statewide out-of-hospital DNR protocol and,
11-23 where applicable, locally adopted out-of-hospital DNR protocols not
11-24 in conflict with the statewide protocol if:
11-25 (1) the responding health care professionals discover
11-26 an executed or issued out-of-hospital DNR order form on their
11-27 arrival at the scene; and
12-1 (2) the responding health care professionals comply
12-2 with this section.
12-3 (b) If the person is wearing a DNR identification device,
12-4 the responding health care professionals must comply with Section
12-5 674.010.
12-6 (c) The responding health care professionals must establish
12-7 the identity of the person as the person who executed or issued the
12-8 out-of-hospital DNR order or for whom the out-of-hospital DNR order
12-9 was executed or issued.
12-10 (d) The responding health care professionals must determine
12-11 that the out-of-hospital DNR order form appears to be valid in that
12-12 it includes:
12-13 (1) written responses in the places designated on the
12-14 form for the names, signatures, and other information required of
12-15 persons executing or issuing, or witnessing the execution or
12-16 issuance of, the order;
12-17 (2) a date in the place designated on the form for the
12-18 date the order was executed or issued; and
12-19 (3) the signature of the declarant or persons
12-20 executing or issuing the order and the attending physician in the
12-21 appropriate places designated on the form for indicating that the
12-22 order form has been properly completed.
12-23 (e) If the conditions prescribed by Subsections (a) through
12-24 (d) are not determined to apply by the responding health care
12-25 professionals at the scene, the out-of-hospital DNR order may not
12-26 be honored and life-sustaining procedures otherwise required by law
12-27 or local emergency medical services protocols shall be initiated or
13-1 continued. Health care professionals acting in out-of-hospital
13-2 settings are not required to accept or interpret an out-of-hospital
13-3 DNR order that does not meet the requirements of this chapter.
13-4 (f) The out-of-hospital DNR order form, when available, must
13-5 accompany the person during transport.
13-6 (g) A record shall be made and maintained of the
13-7 circumstances of each emergency medical services response in which
13-8 an out-of-hospital DNR order or DNR identification device is
13-9 encountered, in accordance with the statewide out-of-hospital DNR
13-10 protocol and any applicable local out-of-hospital DNR protocol not
13-11 in conflict with the statewide protocol.
13-12 (h) An out-of-hospital DNR order executed or issued and
13-13 documented or evidenced in the manner prescribed by this chapter is
13-14 valid and shall be honored by responding health care professionals
13-15 unless the person or persons found at the scene:
13-16 (1) identify themselves as the declarant or as the
13-17 attending physician, legal guardian, qualified relative, or agent
13-18 of the person having a durable power of attorney for health care
13-19 who executed or issued the out-of-hospital DNR order on behalf of
13-20 the person; and
13-21 (2) request that cardiopulmonary resuscitation or
13-22 certain other life-sustaining procedures designated by the board be
13-23 initiated or continued.
13-24 (i) If the policies of a health care facility preclude
13-25 compliance with the out-of-hospital DNR order of a person or an
13-26 out-of-hospital DNR order issued by an attending physician on
13-27 behalf of a person who is admitted to or a resident of the
14-1 facility, or if the facility is unwilling to accept DNR
14-2 identification devices as evidence of the existence of an
14-3 out-of-hospital DNR order, that facility shall take all reasonable
14-4 steps to notify the person or, if the person is incompetent, the
14-5 person's guardian or the person or persons having authority to make
14-6 health care treatment decisions on behalf of the person, of the
14-7 facility's policy and shall take all reasonable steps to effect the
14-8 transfer of the person to the person's home or to a facility where
14-9 the provisions of this chapter can be carried out.
14-10 Sec. 674.010. DNR IDENTIFICATION DEVICE. (a) A person who
14-11 has a valid out-of-hospital DNR order under this chapter may wear a
14-12 DNR identification device around the neck or on the wrist as
14-13 prescribed by board rule adopted under Section 674.023.
14-14 (b) The presence of a DNR identification device on the body
14-15 of a person is conclusive evidence that the person has executed or
14-16 issued a valid out-of-hospital DNR order or has a valid
14-17 out-of-hospital DNR order executed or issued on the person's
14-18 behalf. Responding health care professionals shall honor the DNR
14-19 identification device as if a valid out-of-hospital DNR order form
14-20 executed or issued by the person were found in the possession of
14-21 the person.
14-22 Sec. 674.011. Duration of Out-of-Hospital DNR Order. An
14-23 out-of-hospital DNR order is effective until it is revoked as
14-24 prescribed by Section 674.012.
14-25 Sec. 674.012. Revocation of Out-of-Hospital DNR Order.
14-26 (a) A declarant may revoke an out-of-hospital DNR order at any
14-27 time without regard to the declarant's mental state or competency.
15-1 An order may be revoked by:
15-2 (1) the declarant or someone in the declarant's
15-3 presence and at the declarant's direction destroying the order form
15-4 and removing the DNR identification device, if any;
15-5 (2) a person who identifies himself or herself as the
15-6 legal guardian, as a qualified relative, or as the agent of the
15-7 declarant having a durable power of attorney for health care who
15-8 executed the out-of-hospital DNR order or another person in the
15-9 person's presence and at the person's direction destroying the
15-10 order form and removing the DNR identification device, if any;
15-11 (3) the declarant communicating the declarant's intent
15-12 to revoke the order; or
15-13 (4) a person who identifies himself or herself as the
15-14 legal guardian, a qualified relative, or the agent of the declarant
15-15 having a durable power of attorney for health care who executed the
15-16 out-of-hospital DNR order orally stating the person's intent to
15-17 revoke the order.
15-18 (b) An oral revocation under Subsection (a)(3) or (a)(4)
15-19 takes effect only when the declarant or a person who identifies
15-20 himself or herself as the legal guardian, a qualified relative, or
15-21 the agent of the declarant having a durable power of attorney for
15-22 health care who executed the out-of-hospital DNR order communicates
15-23 the intent to revoke the order to the responding health care
15-24 professionals or the attending physician at the scene. The
15-25 responding health care professionals shall record the time, date,
15-26 and place of the revocation in accordance with the statewide
15-27 out-of-hospital DNR protocol and rules adopted by the board and any
16-1 applicable local out-of-hospital DNR protocol. The attending
16-2 physician or the physician's designee shall record in the person's
16-3 medical record the time, date, and place of the revocation and, if
16-4 different, the time, date, and place that the physician received
16-5 notice of the revocation. The attending physician or the
16-6 physician's designee shall also enter the word "VOID" on each page
16-7 of the copy of the order in the person's medical record.
16-8 (c) Except as otherwise provided by this chapter, a person
16-9 is not civilly or criminally liable for failure to act on a
16-10 revocation made under this section unless the person has actual
16-11 knowledge of the revocation.
16-12 Sec. 674.013. Reexecution of Out-of-Hospital DNR Order. A
16-13 declarant may at any time reexecute or reissue an out-of-hospital
16-14 DNR order in accordance with the procedures prescribed by Section
16-15 674.002, including reexecution or reissuance after the declarant is
16-16 diagnosed as having a terminal condition.
16-17 Sec. 674.014. CONFLICT WITH NATURAL DEATH ACT OR DURABLE
16-18 POWER OF ATTORNEY FOR HEALTH CARE. To the extent that an
16-19 out-of-hospital DNR order conflicts with a directive or treatment
16-20 decision executed or issued under Chapter 672 or a durable power of
16-21 attorney for health care executed or issued in accordance with
16-22 Chapter 135, Civil Practice and Remedies Code, the instrument
16-23 executed later in time controls.
16-24 Sec. 674.015. Effect of Out-of-Hospital DNR Order on
16-25 Insurance Policy and Premiums. (a) The fact that a person has
16-26 executed or issued an out-of-hospital DNR order under this chapter
16-27 does not:
17-1 (1) restrict, inhibit, or impair in any manner the
17-2 sale, procurement, or issuance of a life insurance policy to that
17-3 person; or
17-4 (2) modify the terms of an existing life insurance
17-5 policy.
17-6 (b) Notwithstanding the terms of any life insurance policy,
17-7 the fact that cardiopulmonary resuscitation or certain other
17-8 life-sustaining procedures designated by the board are withheld
17-9 from an insured person under this chapter does not legally impair
17-10 or invalidate that person's life insurance policy and may not be a
17-11 factor for the purpose of determining the payability of benefits or
17-12 the cause of death under the life insurance policy.
17-13 (c) A physician, health facility, health care provider,
17-14 insurer, or health care service plan may not require a person to
17-15 execute or issue an out-of-hospital DNR order as a condition for
17-16 obtaining insurance for health care services or receiving health
17-17 care services.
17-18 (d) The fact that a person has executed or issued or failed
17-19 to execute or issue an out-of-hospital DNR order under this chapter
17-20 may not be considered in any way in establishing insurance
17-21 premiums.
17-22 Sec. 674.016. Limitation on Liability for Withholding
17-23 Cardiopulmonary Resuscitation and Certain other Life-Sustaining
17-24 Procedures. (a) A health care professional or health care
17-25 facility or entity that in good faith causes cardiopulmonary
17-26 resuscitation or certain other life-sustaining procedures
17-27 designated by the board to be withheld from a person in accordance
18-1 with this chapter is not civilly liable for that action.
18-2 (b) A health care professional or health care facility or
18-3 entity that in good faith participates in withholding
18-4 cardiopulmonary resuscitation or certain other life-sustaining
18-5 procedures designated by the board from a person in accordance with
18-6 this chapter is not civilly liable for that action.
18-7 (c) A health care professional or health care facility or
18-8 entity that in good faith participates in withholding
18-9 cardiopulmonary resuscitation or certain other life-sustaining
18-10 procedures designated by the board from a person in accordance with
18-11 this chapter is not criminally liable or guilty of unprofessional
18-12 conduct as a result of that action.
18-13 (d) A health care professional or health care facility or
18-14 entity that in good faith causes or participates in withholding
18-15 cardiopulmonary resuscitation or certain other life-sustaining
18-16 procedures designated by the board from a person in accordance with
18-17 this chapter and rules adopted under this chapter is not in
18-18 violation of any other licensing or regulatory laws or rules of
18-19 this state and is not subject to any disciplinary action or
18-20 sanction by any licensing or regulatory agency of this state as a
18-21 result of that action.
18-22 Sec. 674.017. Limitation on Liability for Failure to
18-23 Effectuate Out-of-hospital DNR order. (a) A health care
18-24 professional or health care facility or entity that has no actual
18-25 knowledge of an out-of-hospital DNR order is not civilly or
18-26 criminally liable for failing to act in accordance with the order.
18-27 (b) A health care professional or health care facility or
19-1 entity is not civilly or criminally liable for failing to
19-2 effectuate an out-of-hospital DNR order.
19-3 (c) If an attending physician refuses to execute or comply
19-4 with an out-of-hospital DNR order, the physician shall inform the
19-5 person, the legal guardian or qualified relatives of the person, or
19-6 the agent of the person having a durable power of attorney for
19-7 health care and, if the person or another authorized to act on
19-8 behalf of the person so directs, shall make a reasonable effort to
19-9 transfer the person to another physician who is willing to execute
19-10 or comply with an out-of-hospital DNR order.
19-11 Sec. 674.018. Honoring Out-of-hospital DNR Order Does Not
19-12 Constitute Offense of Aiding Suicide. A person does not commit an
19-13 offense under Section 22.08, Penal Code, by withholding
19-14 cardiopulmonary resuscitation or certain other life-sustaining
19-15 procedures designated by the board from a person in accordance with
19-16 this chapter.
19-17 Sec. 674.019. Criminal Penalty; Prosecution. (a) A person
19-18 commits an offense if the person intentionally conceals, cancels,
19-19 defaces, obliterates, or damages another person's out-of-hospital
19-20 DNR order or DNR identification device without that person's
19-21 consent or the consent of the person or persons authorized to
19-22 execute or issue an out-of-hospital DNR order on behalf of the
19-23 person under this chapter. An offense under this subsection is a
19-24 Class A misdemeanor.
19-25 (b) A person is subject to prosecution for criminal homicide
19-26 under Chapter 19, Penal Code, if the person, with the intent to
19-27 cause cardiopulmonary resuscitation or certain other
20-1 life-sustaining procedures designated by the board to be withheld
20-2 from another person contrary to the other person's desires,
20-3 falsifies or forges an out-of-hospital DNR order or intentionally
20-4 conceals or withholds personal knowledge of a revocation and
20-5 thereby directly causes cardiopulmonary resuscitation and certain
20-6 other life-sustaining procedures designated by the board to be
20-7 withheld from the other person with the result that the other
20-8 person's death is hastened.
20-9 Sec. 674.020. PREGNANT PERSONS. A person may not withhold
20-10 cardiopulmonary resuscitation or certain other life-sustaining
20-11 procedures designated by the board under this chapter from a person
20-12 known by the responding health care professionals to be pregnant.
20-13 Sec. 674.021. Mercy Killing Not Condoned. This chapter does
20-14 not condone, authorize, or approve mercy killing or permit an
20-15 affirmative or deliberate act or omission to end life except to
20-16 permit the natural process of dying as provided by this chapter.
20-17 Sec. 674.022. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
20-18 This chapter does not impair or supersede any legal right or
20-19 responsibility a person may have under a constitution, other
20-20 statute, regulation, or court decision to effect the withholding of
20-21 cardiopulmonary resuscitation or certain other life-sustaining
20-22 procedures designated by the board.
20-23 Sec. 674.023. DUTIES OF DEPARTMENT AND BOARD. (a) The
20-24 board shall, on the recommendation of the department, adopt all
20-25 reasonable and necessary rules to carry out the purposes of this
20-26 chapter, including rules:
20-27 (1) adopting a statewide out-of-hospital DNR order
21-1 protocol that sets out standard procedures for the withholding of
21-2 cardiopulmonary resuscitation and certain other life-sustaining
21-3 procedures by health care professionals acting in out-of-hospital
21-4 settings;
21-5 (2) designating life-sustaining procedures that may be
21-6 included in an out-of-hospital DNR order, including all procedures
21-7 listed in Section 674.001(14)(A)(i) through (vi); and
21-8 (3) governing recordkeeping in circumstances in which
21-9 an out-of-hospital DNR order or DNR identification device is
21-10 encountered by responding health care professionals.
21-11 (b) The rules adopted by the board under Subsection (a) are
21-12 not effective until approved by the Texas State Board of Medical
21-13 Examiners.
21-14 (c) Local emergency medical services authorities may adopt
21-15 local out-of-hospital DNR order protocols if the local protocols do
21-16 not conflict with the statewide out-of-hospital DNR order protocol
21-17 adopted by the board.
21-18 (d) The board by rule shall specify a distinctive standard
21-19 design for a necklace and a bracelet DNR identification device that
21-20 signifies, when worn by a person, that the possessor has executed
21-21 or issued a valid out-of-hospital DNR order under this chapter or
21-22 is a person for whom a valid out-of-hospital DNR order has been
21-23 executed or issued.
21-24 (e) The department shall report to the board from time to
21-25 time regarding issues identified in emergency medical services
21-26 responses in which an out-of-hospital DNR order or DNR
21-27 identification device is encountered. The report may contain
22-1 recommendations to the board for necessary modifications to the
22-2 form of the standard out-of-hospital DNR order or the designated
22-3 life-sustaining procedures listed in the standard out-of-hospital
22-4 DNR order, the statewide out-of-hospital DNR order protocol, or the
22-5 DNR identification devices.
22-6 Sec. 674.024. Recognition of Out-of-Hospital DNR Order
22-7 Executed or Issued in Other State. An out-of-hospital DNR order
22-8 executed, issued, or authorized in another state or a territory or
22-9 possession of the United States in compliance with the law of that
22-10 jurisdiction is effective for purposes of this chapter.
22-11 SECTION 2. This Act takes effect January 1, 1996.
22-12 SECTION 3. The importance of this legislation and the
22-13 crowded condition of the calendars in both houses create an
22-14 emergency and an imperative public necessity that the
22-15 constitutional rule requiring bills to be read on three several
22-16 days in each house be suspended, and this rule is hereby suspended.